Suicidal Ideas in Stroke Patients 3 and 15 Months after Stroke

Abstract

Patients with stroke may have an increased risk of suicide. We sought to examine the frequency and clinical correlates of suicidal ideas 3 and 15 months after stroke. The study group comprised 286 of 486 consecutive patients aged 55–85 years who at 3 and 15 months after ischemic stroke completed a detailed medical, neurological and radiological stroke evaluation, structured measures of cognition (Mini Mental State Examination), emotion (Beck Depression Inventory, BDI), disability (Rankin scale), and assessment of dependent living. Suicidal ideas were present in 9.8% (n = 28) at 3 months’ follow-up and in 14.0% (n = 40) at 15 months’ follow-up. The patients with suicidal ideas were more depressed measured by BDI both at 3 (17.0 vs. 7.9, p < 0.001) and 15 months (20.5 vs. 8.5, p < 0.001) after stroke compared to the patients without suicidal ideas. Patients with suicidal ideas had more often a history of a stroke already before the index stroke (35 vs. 18.3%, p = 0.0154), right-sided stroke (60.0 vs. 41.9%, p = 0.0323), they were more disabled according to the Rankin scale (2.4 vs. 1.9; p = 0.0035) and more dependent in living (45.0 vs. 27.2%, p = 0.023) 15 months after stroke. An independent correlate of suicidal ideas 15 months after stroke was history of prior stroke (OR 2.4; 95% CI 1.14–4.97) in logistic regression analysis. The frequency of suicidal ideas increased with the time elapsed from stroke. Recurrent strokes, depressive symptoms, more disabling stroke and right-sided stroke correlated to suicidal ideas at 15 months after stroke. Early identification of these risk factors may lead to effective therapeutic intervention.

Is Insomnia Associated With Suicidality in Stroke?

“…OTH INSOMNIA AND SUICIDALITY (SI) have been observed in stroke survivors, 1,2 with the frequency of insomnia in these patients ranging from 68% on admission, 1 37% to 57% at 3 to 4 months' follow-up, 3,4 to 49% at 18-month follow-up. 1 Insomnia subsumes difficulties in initiating or maintaining sleep, or early awakening with the inability to fall asleep again.…”

“…3 However, there is a paucity of studies on insomnia in stroke, and the issue tends to be neglected by health care providers. 6 The prevalence of SI in stroke patients ranges from 6.6% in the acute stage, 7 to 10% at 3-month follow-up, 2 and to 14% at 15-month follow-up. 2 The clinical correlates of SI include a younger age, 7 unmarried status, 7 disabling and recurrent strokes, 2 cognitive impairment, 7 and depressive symptoms.…”

“…6 The prevalence of SI in stroke patients ranges from 6.6% in the acute stage, 7 to 10% at 3-month follow-up, 2 and to 14% at 15-month follow-up. 2 The clinical correlates of SI include a younger age, 7 unmarried status, 7 disabling and recurrent strokes, 2 cognitive impairment, 7 and depressive symptoms. 2 Insomnia is a known risk factor for suicide in the general population 8 and is associated with depression 9 and chronic pain.…”

“…2 The clinical correlates of SI include a younger age, 7 unmarried status, 7 disabling and recurrent strokes, 2 cognitive impairment, 7 and depressive symptoms. 2 Insomnia is a known risk factor for suicide in the general population 8 and is associated with depression 9 and chronic pain. 10 A single case report has suggested that insomnia may also be a risk factor for suicide in stroke, 11 although systematic examination of the possible impact of insomnia on SI in stroke remains lacking.…”

Kvalitet Života Pacijenata Sa Depresijom Nakon Moždanog Udara

“…Pohjasvaara i sar. u studiji (2001) su našli da kod pacijenata kod kojih je zabilježen teži neurološki deficit postoje i otežane aktivnosti svakodnevnog života, te iziskuju veću zavisnost od drugih [20]. U studiji koju su sproveli Narushima i Robinson (2002) ispitujući longitudinalne promjene kvaliteta života depresivnih pacijenata nakon moždanog udara, dobili su rezultate koji ukazuju da depresija otežava kognitivni oporavak, fizički oporavak, kvalitet života, te da je više udružena sa smrtnošću pacijenata sa inzultom [21].…”